Patient guide · Running

Back to running after time off

The first three weeks decide whether this goes well. Almost everyone does too much in week one.

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What you lost, and what you did not

Your lungs come back faster than your tendons do. That mismatch is the whole problem.

Aerobic fitness falls slowly. Two or three weeks off costs less than people fear, and it comes back within a few weeks of consistent running.

Tissue tolerance falls faster. Tendons, bone and muscle lose their tolerance for impact quicker than your lungs lose their capacity, and that mismatch is exactly why people get injured on the way back. You feel fine, so you run like you are fine.

Every step loads the calf, the knee and the foot in sequence. Tissue that has not done it for six weeks needs reminding gradually.

About the ten per cent rule

You will have been told to increase by no more than ten per cent a week. It is a reasonable brake and it is worth knowing where it came from, which is not a trial.

When it was tested in novice runners, a graded programme built on the ten per cent rule did not reduce injuries compared with a faster progression. What the evidence does support is that large jumps in weekly distance are followed by more injuries. So the principle holds even though the number is arbitrary.

Use it as a sanity check rather than a law. If your week has jumped by a third, something usually complains.

The first month

Almost everyone does too much in week one. Week one is three runs of twenty minutes, one minute running and one minute walking, with nothing built on top. Week two is three runs of twenty-five minutes with longer running blocks. Week three is three runs of thirty minutes, mostly continuous. In both of those weeks, build time only.

In week four, add pace or a hill, not both. One variable at a time.

The check that keeps you honest

Judge every run by the next morning. Stiffness that eases in ten minutes is fine. Pain that is worse than the day before means the last run was too much.

Pain up to about five out of ten during a run is workable provided it has settled by the next morning and is not creeping up week on week. Two consecutive mornings worse means drop back a week in the plan rather than push through it.

If you are coming back from an injury rather than a holiday, a side to side difference in strength above ten per cent is the thing that most often explains why the same injury keeps coming back, and it is easy to retest once you have the first number.

Try this first

  • Week one, three runs of twenty minutes, walk and run in one minute blocks
  • Add five minutes per run per week, nothing else
  • Keep one strength session a week going alongside it
  • Use the next morning as the measure, every time

Get it looked at if

  • Pain you can cover with a fingertip, on bone
  • A limp. If you have to change how you run, stop running
  • Pain that gets worse as the run goes on rather than easing
  • Swelling in a joint after a run

What we would do

If you are coming back from an injury rather than a holiday, we test the leg before you build. Calf and quadriceps strength, hop symmetry and landing mechanics tell us whether the tissue is ready for what you are about to ask of it.

Book an initial assessment, £55

Want this as a one-page sheet?

The version we hand out in clinic. Print it, stick it on the fridge, work through it.

We use your email to send the sheet and, if you tick the box, our physiotherapy newsletter. We never share it and never pass it to The Aesthetics Table.

Related: Gait analysis for runners · All patient guides · Our blog

This guide is general information about a common problem, not a diagnosis of yours. If something is not settling, or it does not match what is written here, come and get it looked at.